H-0051.6 _______________________________________________
HOUSE BILL 1761
_______________________________________________
State of Washington 57th Legislature 2001 Regular Session
By Representatives Ogden, Tokuda, Edmonds, Dunshee, Ruderman, Delvin, Cody, Jarrett, Edwards, Darneille, Kagi and Santos
Read first time 02/02/2001. Referred to Committee on Health Care.
AN ACT Relating to licensed mental health counselors, marriage and family therapists, and social workers; amending RCW 18.120.020, 18.130.040, 5.60.060, 18.100.050, 18.205.090, 25.05.510, 25.15.045, and 48.43.087; reenacting and amending RCW 9A.44.010; adding a new section to chapter 70.02 RCW; adding a new chapter to Title 18 RCW; and repealing RCW 18.19.010, 18.19.020, 18.19.030, 18.19.040, 18.19.050, 18.19.060, 18.19.070, 18.19.080, 18.19.090, 18.19.100, 18.19.110, 18.19.120, 18.19.130, 18.19.140, 18.19.150, 18.19.160, 18.19.170, 18.19.180, 18.19.190, 18.19.900, and 18.19.901.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Advanced social work" means the knowledge and ability to apply social work theory and methods including emotional and biopsychosocial assessment, psychotherapy under the supervision of a licensed independent clinical social worker, case management, consultation, advocacy, counseling, and community organization.
(2) "Applicant" means a person who completes the required application, pays the required fee, is at least eighteen years of age, and meets any background check requirements and uniform disciplinary act requirements.
(3) "Commission" means the Washington state mental health counselors, marriage and family therapists, and social workers quality assurance commission.
(4) "Department" means the department of health.
(5) "Disciplining authority" means the commission.
(6) "Independent clinical social work" means the knowledge and ability to diagnose and treat emotional disorders through accepted mental health practices in counseling, psychotherapy, and social work practice as defined in the advanced social work. Treatment modalities include but are not limited to work with children, adolescents, and/or adults, as individuals, in couples, families, groups, or organizations.
(7) "Marriage and family therapy" means the diagnosis and treatment of mental and emotional disorders, whether cognitive, affective, or behavioral, within the context of relationships, including marriage and family systems. Marriage and family therapy involves the professional application of psychotherapeutic and family systems theories and techniques in the delivery of services to individuals, couples, and families for the purpose of treating such diagnosed nervous and mental disorders.
(8) "Mental health counseling" means the application of principles of human development, learning theory, psychotherapy, group dynamics, and etiology of mental illness and dysfunctional behavior to individuals, couples, families, groups, and organizations, for the purpose of treatment of mental disorders and promoting optimal mental health and functionality. Mental health counseling also includes, but is not limited to, the assessment, diagnosis, and treatment of mental and emotional disorders, as well as the application of a wellness model of mental health.
(9) "Practice of marriage and family therapy" means the rendering of professional marriage and family therapy services to individuals, couples, and families, singly or in groups, whether such services are offered directly to the general public or through organizations, either public or private, for a fee, monetary or otherwise.
(10) "Secretary" means the secretary of health or the secretary's designee.
NEW SECTION. Sec. 2. A person must not represent himself or herself as a licensed advanced social worker, licensed independent clinical social worker, licensed mental health counselor, or licensed marriage and family therapist, without applying for licensure, meeting the required qualifications, and being licensed by the department, unless otherwise exempted by this chapter.
NEW SECTION. Sec. 3. Nothing in this chapter shall be construed to prohibit or restrict:
(1) The practice of marriage and family therapy, mental health counseling, and social work by an individual otherwise regulated under this title and performing services within the authorized scope of practice;
(2) The practice of marriage and family therapy, mental health counseling, and social work by an individual employed by the government of the United States while engaged in the performance of duties prescribed by the laws of the United States;
(3) The practice of marriage and family therapy, mental health counseling, and social work by a person who is a regular student in an educational program approved by the commission, and whose performance of services is pursuant to a regular course of instruction or assignments from an instructor and under the general supervision of the instructor;
(4) The practice of marriage and family therapy, mental health counseling, and social work by a person issued a temporary permit by the commission;
(5) The practice of marriage and family therapy, mental health counseling, and social work employed by a religious denomination, church, or religious organization.
NEW SECTION. Sec. 4. In addition to any other authority provided by law, the secretary has the authority to:
(1) Adopt rules under chapter 34.05 RCW necessary to implement this chapter;
(2) Establish all licensing, examination, and renewal fees in accordance with RCW 43.70.250;
(3) Establish forms and procedures necessary to administer this chapter;
(4) Issue licenses to applicants who have met the education, training, and examination requirements for licensure and to deny a license to applicants who do not meet the requirements, except that proceedings concerning the denial of licensure based upon unprofessional conduct or impairment shall be governed by the commission and by the uniform disciplinary act, chapter 18.130 RCW;
(5) Hire clerical, administrative, investigative, and other staff as needed to implement this chapter, and hire individuals licensed under this chapter to serve as examiners for any practical examinations;
(6) Administer and supervise the grading and taking of examinations for applicants for licensure;
(7) Determine which states have credentialing requirements substantially equivalent to those of this state, and issue licenses to individuals credentialed in those states without examinations;
(8) Implement and administer a program for consumer education in consultation with the commission;
(9) Adopt rules implementing a continuing education program in consultation with the commission;
(10) Maintain the official record of all applicants and licensees; and
(11) Establish by rule the procedures for an appeal of an examination failure.
NEW SECTION. Sec. 5. The secretary shall keep an official record of all proceedings. A part of the record shall consist of a register of all applicants for licensing under this chapter and the results of each application.
NEW SECTION. Sec. 6. The Washington state mental health counselors, marriage and family therapists, and social workers quality assurance commission is established.
(1) The commission shall be comprised of nine members. Two members shall be licensed mental health counselors. Two members shall be licensed marriage and family therapists. One member shall be a licensed independent clinical social worker, and one member shall be a licensed advanced social worker. Three members must be consumers and represent the public at large and may not be licensed mental health care providers.
(2) Three members shall be appointed for a term of one year, three members shall be appointed for a term of two years, and three members shall be appointed for a term of three years. Subsequent members shall be appointed for terms of three years. A person must not serve as a member for more than two consecutive terms.
(3)(a) Each member must be a resident of the state of Washington.
(b) Each member must not hold an office in a professional association for mental health, social work, or marriage and family therapy and must not be employed by the state of Washington.
(c) Each professional member must have been actively engaged as a mental health counselor, marriage and family therapist, or social worker for five years immediately preceding appointment.
(d) The consumer members must represent the general public and be unaffiliated directly or indirectly with the professions licensed under this chapter.
(4) The governor shall appoint the commission members. The governor shall fill any vacancy for the unexpired term by appointment.
(5) A quorum of five commission members is required for purposes of transacting business.
(6) Commissioners are immune from suit in an action, civil or criminal, based on its disciplinary proceedings or other official acts performed in good faith.
(7) Commissioners shall be compensated in accordance with RCW 43.03.240, including travel expenses in carrying out his or her authorized duties in accordance with RCW 43.03.050 and 43.03.060.
(8) The commission shall elect a chair and vice-chair.
NEW SECTION. Sec. 7. The disciplining authority has the following authority:
(1) To adopt, amend, and rescind such rules as are deemed necessary to carry out this chapter;
(2) To investigate all complaints or reports of unprofessional conduct as defined in this chapter and to hold hearings as provided in this chapter;
(3) To issue subpoenas and administer oaths in connection with any investigation, hearing, or proceeding held under this chapter;
(4) To take or cause depositions to be taken and use other discovery procedures as needed in any investigation, hearing, or proceeding held under this chapter;
(5) To compel attendance of witnesses at hearings;
(6) To take emergency action ordering summary suspension of a license, or restriction or limitation of the licensee's practice pending proceedings by the disciplining authority;
(7) To use a presiding officer as authorized in RCW 18.130.095(3) or the office of administrative hearings as authorized in chapter 34.12 RCW to conduct hearings. The disciplining authority shall make the final decision regarding disposition of the license unless the disciplining authority elects to delegate in writing the final decision to the presiding officer;
(8) To use licensed members of the commission to direct investigations;
(9) To enter into contracts for professional services determined to be necessary for adequate enforcement of this chapter;
(10) To contract with licensees or other persons or organizations to provide services necessary for the monitoring and supervision of licensees who are placed on probation, whose professional activities are restricted, or who are for any authorized purpose subject to monitoring by the disciplining authority;
(11) To adopt standards of professional conduct or practice;
(12) To grant or deny license applications, and in the event of a finding of unprofessional conduct by an applicant or license holder, to impose any sanction against a license applicant or license holder provided by this chapter;
(13) To designate individuals authorized to sign subpoenas and statements of charges;
(14) To establish panels consisting of three or more members of the commission to perform any duty or authority within the commission's jurisdiction under this chapter;
(15) To review and audit the records of health facilities in which a licensee's practice privilege or employment is terminated or restricted. Each health facility shall produce and make accessible to the disciplining authority the appropriate records and otherwise facilitate the review and audit. Information so gained shall not be subject to discovery or introduction into evidence in any civil action pursuant to RCW 70.41.200(3).
NEW SECTION. Sec. 8. (1) The secretary shall issue a license to any applicant who demonstrates to the satisfaction of the commission that the applicant meets the following education and experience requirements for the applicant's practice area.
(a) Licensed social work classifications:
(i) Licensed advanced social worker:
(A) Graduation from a master's or doctorate educational program approved by the commission based upon nationally recognized standards;
(B) Successful completion of an approved examination; and
(C) Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of three thousand two hundred hours of experience, of which eight hundred hours must be direct client contact, over a two-year period as a licensed social worker, with supervision of at least ninety hours by a licensed mental health practitioner. Of the total supervision, fifty hours must be with an independent clinical social worker; the other forty hours may be with an equally qualified mental health practitioner. Forty hours must be in one-to-one supervision and fifty hours may be in one-to-one supervision or group supervision. Distance supervision is limited to forty supervision hours.
(ii) Licensed independent clinical social worker:
(A) Graduation from a master's or doctorate level educational program approved by the commission based upon nationally recognized standards;
(B) Successful completion of an approved examination; and
(C) Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of four thousand hours of experience, of which one thousand hours must be direct client contact, over a three-year period as a licensed social worker, licensed master level social worker, or licensed advanced social worker, with supervision of at least one hundred thirty hours by a licensed mental health practitioner. Of the total supervision, seventy hours must be with an independent clinical social worker; the other sixty hours may be with an equally qualified mental health practitioner. Sixty hours must be in one-to-one supervision and seventy hours may be in one-to-one supervision or group supervision. Distance supervision is limited to sixty supervision hours.
(b) Licensed mental health counselor:
(i) Graduation from a master's or doctoral level educational program in mental health counseling or a related discipline from a college or university approved by the commission based upon nationally recognized standards;
(ii) Successful completion of an approved examination; and
(iii) Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of thirty-six months full-time counseling or three thousand hours of postgraduate mental health counseling under the supervision of a qualified licensed mental health counselor in an approved setting. The three thousand hours of required experience includes a minimum of one hundred hours spent in immediate supervision with the qualified licensed mental health counselor, and includes a minimum of one thousand two hundred hours of direct counseling with individuals, couples, families, or groups.
(c) Licensed marriage and family therapist:
Graduation from a master's degree or doctoral degree educational program in marriage and family therapy or graduation from an educational program in an allied field equivalent to a master's degree or doctoral degree in marriage and family therapy approved by the commission based upon nationally recognized standards.
(d) Licensed marriage and family therapist:
(i) Graduation from a master's degree or doctoral degree educational program in marriage and family therapy or graduation from an educational program in an allied field equivalent to a master's degree or doctoral degree in marriage and family therapy approved by the commission based upon nationally recognized standards;
(ii) Successful passage of an approved examination; and
(iii) Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of two calendar years of full-time marriage and family therapy. Of the total supervision, one hundred hours must be with a licensed marriage and family therapist with at least five years' clinical experience; the other one hundred hours may be with an equally qualified mental health practitioner. Total experience requirements include:
(A) A minimum of three thousand hours of experience, one thousand hours of which must be direct client contact; at least five hundred hours must be gained in diagnosing and treating couples and families; plus
(B) At least two hundred hours of qualified supervision with a supervisor. At least one hundred of the two hundred hours must be one-on-one supervision, and the remaining hours may be in one-on-one or group supervision.
Applicants who have completed a master's program accredited by the commission on accreditation for marriage and family therapy education of the American association for marriage and family therapy may be credited with five hundred hours of direct client contact and one hundred hours of formal meetings with an approved supervisor.
(2) The commission shall establish by rule what constitutes adequate proof of meeting the criteria.
(3) In addition, applicants shall be subject to the grounds for denial of a license or issuance of a conditional license under chapter 18.130 RCW.
NEW SECTION. Sec. 9. Mental health counselors, marriage and family therapists, and social workers licensed under this chapter shall biennially attend at least thirty-six hours of continuing education approved by the commission as a condition of license renewal, of which six hours must be devoted to professional law and ethics. In approving the curricula, the commission shall consider the educational and training standards of nationally recognized professional organizations of social work, mental health counseling, and marriage and family therapy and accredited schools offering graduate degrees in these programs in the state of Washington.
NEW SECTION. Sec. 10. The commission shall establish by rule educational, experience, and alternative training requirements. The commission may utilize or contract with individuals or organizations having expertise in the profession or in education to assist in the evaluations. The commission shall establish by rule the standards and procedures for revocation of approval of education programs. The standards and procedures set shall apply equally to educational programs and training in the United States and in foreign jurisdictions. The secretary may establish a fee for educational program evaluations.
NEW SECTION. Sec. 11. A person licensed under this chapter must provide clients at the commencement of any program of treatment with accurate disclosure information concerning the practice, in accordance with rules adopted by the commission, including the right of clients to refuse treatment, the responsibility of clients to choose the provider and treatment modality which best suits their needs, and the extent of confidentiality provided by this chapter. The disclosure information must also include the license holder's professional education and training, the therapeutic orientation of the practice, the proposed course of treatment where known, financial requirements, and such other information as required by rule. The disclosure must be acknowledged in writing by the client and license holder.
NEW SECTION. Sec. 12. (1) The date and location of examinations shall be established by the secretary. Applicants who have been found by the secretary to meet the other requirements for licensure shall be scheduled for the next examination following the filing of the application. The secretary shall establish by rule the examination application deadline.
(2) The secretary or the secretary's designees shall examine each applicant, by means determined most effective, on subjects appropriate to the scope of practice, as applicable. Such examinations shall be limited to the purpose of determining whether the applicant possesses the minimum skill and knowledge necessary to practice competently.
(3) The examination papers, all grading of the papers, and the grading of any practical work shall be preserved for a period of not less than one year after the secretary has made and published the decisions. All examinations shall be conducted under fair and wholly impartial methods.
(4) Any applicant failing to make the required grade in the first examination may take up to three subsequent examinations as the applicant desires upon prepaying a fee determined by the secretary under RCW 43.70.250 for each subsequent examination. Upon failing four examinations, the secretary may invalidate the original application and require such remedial education before the person may take future examinations.
(5) The secretary may approve an examination prepared or administered by a private testing agency or association of licensing agencies for use by an applicant in meeting the licensing requirements.
NEW SECTION. Sec. 13. Applications for licensing shall be submitted on forms provided by the secretary. The secretary may require any information and documentation which reasonably relates to the need to determine whether the applicant meets the criteria for licensing provided for in this chapter and chapter 18.130 RCW. Each applicant shall pay a fee determined by the secretary under RCW 43.70.250. The fee shall accompany the application.
NEW SECTION. Sec. 14. Any person certified for more than one year under chapter 18.19 RCW is eligible for a license as an advanced social worker, an independent clinical social worker, a marriage and family therapist, or a mental health counselor under this chapter without taking the examination. Any person who is a certified social worker and has been licensed for less than a year may become licensed if the additional supervision and experience requirements are met.
NEW SECTION. Sec. 15. An applicant holding a credential in another state may be licensed to practice in this state without examination if the commission determines that the other state's credentialing standards are substantially equivalent to the licensing standards in this state.
NEW SECTION. Sec. 16. The secretary shall establish by rule the procedural requirements and fees for renewal of a license. Failure to renew shall invalidate the license and all privileges granted by the license. If a license has lapsed for a period longer than three years, the person shall demonstrate competence to the satisfaction of the commission by taking continuing education courses, or meeting other standards determined by the secretary.
NEW SECTION. Sec. 17. The uniform disciplinary act, chapter 18.130 RCW, shall govern the issuance and denial of licenses, unauthorized practice, and the discipline of persons licensed under this chapter. The commission, with the assistance of the secretary, shall be the disciplining authority under this chapter and may adopt rules establishing additional standards of unprofessional conduct for persons licensed under this chapter.
NEW SECTION. Sec. 18. This chapter shall not be construed as permitting the administration or prescription of drugs or in any way infringing upon the practice of medicine and surgery as defined in chapter 18.71 RCW, or in any way infringing upon the practice of psychology as defined in chapter 18.83 RCW, or restricting the scope of the practice of counseling for those registered under chapter 18.19 RCW, or restricting the scope of practice of persons licensed under this chapter.
Sec. 19. RCW 18.120.020 and 2000 c 93 s 15 are each amended to read as follows:
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Applicant group" includes any health professional group or organization, any individual, or any other interested party which proposes that any health professional group not presently regulated be regulated or which proposes to substantially increase the scope of practice of the profession.
(2) "Certificate" and "certification" mean a voluntary process by which a statutory regulatory entity grants recognition to an individual who (a) has met certain prerequisite qualifications specified by that regulatory entity, and (b) may assume or use "certified" in the title or designation to perform prescribed health professional tasks.
(3) "Grandfather clause" means a provision in a regulatory statute applicable to practitioners actively engaged in the regulated health profession prior to the effective date of the regulatory statute which exempts the practitioners from meeting the prerequisite qualifications set forth in the regulatory statute to perform prescribed occupational tasks.
(4) "Health
professions" means and includes the following health and health-related
licensed or regulated professions and occupations: Podiatric medicine and
surgery under chapter 18.22 RCW; chiropractic under chapter 18.25 RCW; dental
hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW; denturism
under chapter 18.30 RCW; dispensing opticians under chapter 18.34 RCW; hearing
instruments under chapter 18.35 RCW; naturopaths under chapter 18.36A RCW;
embalming and funeral directing under chapter 18.39 RCW; midwifery under
chapter 18.50 RCW; nursing home administration under chapter 18.52 RCW;
optometry under chapters 18.53 and 18.54 RCW; ocularists under chapter 18.55
RCW; osteopathic medicine and surgery under chapters 18.57 and 18.57A RCW;
pharmacy under chapters 18.64 and 18.64A RCW; medicine under chapters 18.71 and
18.71A RCW; emergency medicine under chapter 18.73 RCW; physical therapy under
chapter 18.74 RCW; practical nurses under chapter 18.79 RCW; psychologists
under chapter 18.83 RCW; registered nurses under chapter 18.79 RCW;
occupational therapists licensed under chapter 18.59 RCW; respiratory care
practitioners licensed under chapter 18.89 RCW; veterinarians and veterinary
technicians under chapter 18.92 RCW; health care assistants under chapter
18.135 RCW; massage practitioners under chapter 18.108 RCW; acupuncturists
licensed under chapter 18.06 RCW; ((persons registered or certified under
chapter 18.19 RCW;)) persons licensed as mental health counselors,
marriage and family therapists, and social workers under chapter 18.-- RCW
(sections 1 through 18 of this act); dietitians and nutritionists certified
by chapter 18.138 RCW; radiologic technicians under chapter 18.84 RCW; and
nursing assistants registered or certified under chapter 18.88A RCW.
(5) "Inspection" means the periodic examination of practitioners by a state agency in order to ascertain whether the practitioners' occupation is being carried out in a fashion consistent with the public health, safety, and welfare.
(6) "Legislative committees of reference" means the standing legislative committees designated by the respective rules committees of the senate and house of representatives to consider proposed legislation to regulate health professions not previously regulated.
(7) "License," "licensing," and "licensure" mean permission to engage in a health profession which would otherwise be unlawful in the state in the absence of the permission. A license is granted to those individuals who meet prerequisite qualifications to perform prescribed health professional tasks and for the use of a particular title.
(8) "Professional license" means an individual, nontransferable authorization to carry on a health activity based on qualifications which include: (a) Graduation from an accredited or approved program, and (b) acceptable performance on a qualifying examination or series of examinations.
(9) "Practitioner" means an individual who (a) has achieved knowledge and skill by practice, and (b) is actively engaged in a specified health profession.
(10) "Public member" means an individual who is not, and never was, a member of the health profession being regulated or the spouse of a member, or an individual who does not have and never has had a material financial interest in either the rendering of the health professional service being regulated or an activity directly related to the profession being regulated.
(11) "Registration" means the formal notification which, prior to rendering services, a practitioner shall submit to a state agency setting forth the name and address of the practitioner; the location, nature and operation of the health activity to be practiced; and, if required by the regulatory entity, a description of the service to be provided.
(12) "Regulatory entity" means any board, commission, agency, division, or other unit or subunit of state government which regulates one or more professions, occupations, industries, businesses, or other endeavors in this state.
(13) "State agency" includes every state office, department, board, commission, regulatory entity, and agency of the state, and, where provided by law, programs and activities involving less than the full responsibility of a state agency.
Sec. 20. RCW 18.130.040 and 1999 c 335 s 10 are each amended to read as follows:
(1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.
(2)(a) The secretary has authority under this chapter in relation to the following professions:
(i) Dispensing opticians licensed under chapter 18.34 RCW;
(ii) Naturopaths licensed under chapter 18.36A RCW;
(iii) Midwives licensed under chapter 18.50 RCW;
(iv) Ocularists licensed under chapter 18.55 RCW;
(v) Massage operators and businesses licensed under chapter 18.108 RCW;
(vi) Dental hygienists licensed under chapter 18.29 RCW;
(vii) Acupuncturists licensed under chapter 18.06 RCW;
(viii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
(ix) Respiratory care practitioners licensed under chapter 18.89 RCW;
(x) ((Persons
registered or certified under chapter 18.19 RCW)) Persons licensed as
mental health counselors, marriage and family therapists, and social workers
under chapter 18.-- RCW (sections 1 through 18 of this act);
(xi) Persons registered as nursing pool operators under chapter 18.52C RCW;
(xii) Nursing assistants registered or certified under chapter 18.88A RCW;
(xiii) Health care assistants certified under chapter 18.135 RCW;
(xiv) Dietitians and nutritionists certified under chapter 18.138 RCW;
(xv) Chemical dependency professionals certified under chapter 18.205 RCW;
(xvi) Sex offender treatment providers certified under chapter 18.155 RCW;
(xvii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
(xviii) Persons registered as adult family home providers and resident managers under RCW 18.48.020;
(xix) Denturists licensed under chapter 18.30 RCW;
(xx) Orthotists and prosthetists licensed under chapter 18.200 RCW; and
(xxi) Surgical technologists registered under chapter 18.215 RCW.
(b) The boards and commissions having authority under this chapter are as follows:
(i) The podiatric medical board as established in chapter 18.22 RCW;
(ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;
(iii) The dental quality assurance commission as established in chapter 18.32 RCW;
(iv) The board of hearing and speech as established in chapter 18.35 RCW;
(v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
(vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
(vii) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;
(viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
(ix) The medical quality assurance commission as established in chapter 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;
(x) The board of physical therapy as established in chapter 18.74 RCW;
(xi) The board of occupational therapy practice as established in chapter 18.59 RCW;
(xii) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses issued under that chapter;
(xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW; and
(xiv) The veterinary board of governors as established in chapter 18.92 RCW.
(3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses based on the conditions and criteria established in this chapter and the chapters specified in subsection (2) of this section. This chapter also governs any investigation, hearing, or proceeding relating to denial of licensure or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160 by the disciplining authority.
(4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.
Sec. 21. RCW 5.60.060 and 1998 c 72 s 1 are each amended to read as follows:
(1) A husband shall not be examined for or against his wife, without the consent of the wife, nor a wife for or against her husband without the consent of the husband; nor can either during marriage or afterward, be without the consent of the other, examined as to any communication made by one to the other during marriage. But this exception shall not apply to a civil action or proceeding by one against the other, nor to a criminal action or proceeding for a crime committed by one against the other, nor to a criminal action or proceeding against a spouse if the marriage occurred subsequent to the filing of formal charges against the defendant, nor to a criminal action or proceeding for a crime committed by said husband or wife against any child of whom said husband or wife is the parent or guardian, nor to a proceeding under chapter 70.96A or 71.05 RCW: PROVIDED, That the spouse of a person sought to be detained under chapter 70.96A or 71.05 RCW may not be compelled to testify and shall be so informed by the court prior to being called as a witness.
(2)(a) An attorney or counselor shall not, without the consent of his or her client, be examined as to any communication made by the client to him or her, or his or her advice given thereon in the course of professional employment.
(b) A parent or guardian of a minor child arrested on a criminal charge may not be examined as to a communication between the child and his or her attorney if the communication was made in the presence of the parent or guardian. This privilege does not extend to communications made prior to the arrest.
(3) A member of the clergy or a priest shall not, without the consent of a person making the confession, be examined as to any confession made to him or her in his or her professional character, in the course of discipline enjoined by the church to which he or she belongs.
(4) Subject to the limitations under RCW 70.96A.140 or 71.05.250, a physician or surgeon or osteopathic physician or surgeon or podiatric physician or surgeon shall not, without the consent of his or her patient, be examined in a civil action as to any information acquired in attending such patient, which was necessary to enable him or her to prescribe or act for the patient, except as follows:
(a) In any judicial proceedings regarding a child's injury, neglect, or sexual abuse or the cause thereof; and
(b) Ninety days after filing an action for personal injuries or wrongful death, the claimant shall be deemed to waive the physician-patient privilege. Waiver of the physician-patient privilege for any one physician or condition constitutes a waiver of the privilege as to all physicians or conditions, subject to such limitations as a court may impose pursuant to court rules.
(5) A public officer shall not be examined as a witness as to communications made to him or her in official confidence, when the public interest would suffer by the disclosure.
(6)(a) A peer support group counselor shall not, without consent of the law enforcement officer making the communication, be compelled to testify about any communication made to the counselor by the officer while receiving counseling. The counselor must be designated as such by the sheriff, police chief, or chief of the Washington state patrol, prior to the incident that results in counseling. The privilege only applies when the communication was made to the counselor while acting in his or her capacity as a peer support group counselor. The privilege does not apply if the counselor was an initial responding officer, a witness, or a party to the incident which prompted the delivery of peer support group counseling services to the law enforcement officer.
(b) For purposes of this section, "peer support group counselor" means a:
(i) Law enforcement officer, or civilian employee of a law enforcement agency, who has received training to provide emotional and moral support and counseling to an officer who needs those services as a result of an incident in which the officer was involved while acting in his or her official capacity; or
(ii) Nonemployee counselor who has been designated by the sheriff, police chief, or chief of the Washington state patrol to provide emotional and moral support and counseling to an officer who needs those services as a result of an incident in which the officer was involved while acting in his or her official capacity.
(7) A sexual assault advocate may not, without the consent of the victim, be examined as to any communication made by the victim to the sexual assault advocate.
(a) For purposes of this section, "sexual assault advocate" means the employee or volunteer from a rape crisis center, victim assistance unit, program, or association, that provides information, medical or legal advocacy, counseling, or support to victims of sexual assault, who is designated by the victim to accompany the victim to the hospital or other health care facility and to proceedings concerning the alleged assault, including police and prosecution interviews and court proceedings.
(b) A sexual assault advocate may disclose a confidential communication without the consent of the victim if failure to disclose is likely to result in a clear, imminent risk of serious physical injury or death of the victim or another person. Any sexual assault advocate participating in good faith in the disclosing of records and communications under this section shall have immunity from any liability, civil, criminal, or otherwise, that might result from the action. In any proceeding, civil or criminal, arising out of a disclosure under this section, the good faith of the sexual assault advocate who disclosed the confidential communication shall be presumed.
(8) A licensed mental health counselor, marriage and family therapist, or social worker shall not be examined as to any communications made by his or her client to the licensed mental health counselor, marriage and family therapist, or social worker in the course of the professional relationship without the consent of his or her client. This privilege is limited by the mental health counselor, marriage and family therapist, or social worker's duty to mandatorily report abuse and neglect. This privilege is limited by the mental health counselor, marriage and family therapist, or social worker's duty to warn of and protect from a client's threatened violent behavior if the client communicated a serious threat of physical violence against a reasonably identifiable victim or victims. Communications remain confidential and privileged even under circumstances where the client's parent, in the case of a minor, is present at the time of the communication.
Sec. 22. RCW 9A.44.010 and 1997 c 392 s 513 and 1997 c 112 s 37 are each reenacted and amended to read as follows:
As used in this chapter:
(1) "Sexual intercourse" (a) has its ordinary meaning and occurs upon any penetration, however slight, and
(b) Also means any penetration of the vagina or anus however slight, by an object, when committed on one person by another, whether such persons are of the same or opposite sex, except when such penetration is accomplished for medically recognized treatment or diagnostic purposes, and
(c) Also means any act of sexual contact between persons involving the sex organs of one person and the mouth or anus of another whether such persons are of the same or opposite sex.
(2) "Sexual contact" means any touching of the sexual or other intimate parts of a person done for the purpose of gratifying sexual desire of either party or a third party.
(3) "Married" means one who is legally married to another, but does not include a person who is living separate and apart from his or her spouse and who has filed in an appropriate court for legal separation or for dissolution of his or her marriage.
(4) "Mental incapacity" is that condition existing at the time of the offense which prevents a person from understanding the nature or consequences of the act of sexual intercourse whether that condition is produced by illness, defect, the influence of a substance or from some other cause.
(5) "Physically helpless" means a person who is unconscious or for any other reason is physically unable to communicate unwillingness to an act.
(6) "Forcible compulsion" means physical force which overcomes resistance, or a threat, express or implied, that places a person in fear of death or physical injury to herself or himself or another person, or in fear that she or he or another person will be kidnapped.
(7) "Consent" means that at the time of the act of sexual intercourse or sexual contact there are actual words or conduct indicating freely given agreement to have sexual intercourse or sexual contact.
(8) "Significant relationship" means a situation in which the perpetrator is:
(a) A person who undertakes the responsibility, professionally or voluntarily, to provide education, health, welfare, or organized recreational activities principally for minors;
(b) A person who in the course of his or her employment supervises minors; or
(c) A person who provides welfare, health or residential assistance, personal care, or organized recreational activities to frail elders or vulnerable adults, including a provider, employee, temporary employee, volunteer, or independent contractor who supplies services to long-term care facilities licensed or required to be licensed under chapter 18.20, 18.51, 72.36, or 70.128 RCW, and home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW, but not including a consensual sexual partner.
(9) "Abuse of a supervisory position" means a direct or indirect threat or promise to use authority to the detriment or benefit of a minor.
(10) "Developmentally disabled," for purposes of RCW 9A.44.050(1)(c) and 9A.44.100(1)(c), means a person with a developmental disability as defined in RCW 71A.10.020.
(11) "Person with supervisory authority," for purposes of RCW 9A.44.050(1) (c) or (e) and 9A.44.100(1) (c) or (e), means any proprietor or employee of any public or private care or treatment facility who directly supervises developmentally disabled, mentally disordered, or chemically dependent persons at the facility.
(12) "Mentally disordered person" for the purposes of RCW 9A.44.050(1)(e) and 9A.44.100(1)(e) means a person with a "mental disorder" as defined in RCW 71.05.020.
(13) "Chemically dependent person" for purposes of RCW 9A.44.050(1)(e) and 9A.44.100(1)(e) means a person who is "chemically dependent" as defined in RCW 70.96A.020(4).
(14) "Health care
provider" for purposes of RCW 9A.44.050 and 9A.44.100 means a person who
is, holds himself or herself out to be, or provides services as if he or she
were: (a) A member of a health care profession under chapter 18.130 RCW; or
(b) ((registered or certified under chapter 18.19 RCW)) licensed
under chapter 18.-- RCW (sections 1 through 18 of this act), regardless of
whether the health care provider is licensed, certified, or registered by the
state.
(15) "Treatment" for purposes of RCW 9A.44.050 and 9A.44.100 means the active delivery of professional services by a health care provider which the health care provider holds himself or herself out to be qualified to provide.
(16) "Frail elder or vulnerable adult" means a person sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself. "Frail elder or vulnerable adult" also includes a person found incapacitated under chapter 11.88 RCW, a person over eighteen years of age who has a developmental disability under chapter 71A.10 RCW, a person admitted to a long-term care facility that is licensed or required to be licensed under chapter 18.20, 18.51, 72.36, or 70.128 RCW, and a person receiving services from a home health, hospice, or home care agency licensed or required to be licensed under chapter 70.127 RCW.
Sec. 23. RCW 18.100.050 and 1999 c 128 s 1 are each amended to read as follows:
(1) An individual or group of individuals duly licensed or otherwise legally authorized to render the same professional services within this state may organize and become a shareholder or shareholders of a professional corporation for pecuniary profit under the provisions of Title 23B RCW for the purpose of rendering professional service. One or more of the legally authorized individuals shall be the incorporators of the professional corporation.
(2) Notwithstanding any other provision of this chapter, registered architects and registered engineers may own stock in and render their individual professional services through one professional service corporation.
(3) Licensed health care professionals, providing services to enrolled participants either directly or through arrangements with a health maintenance organization registered under chapter 48.46 RCW or federally qualified health maintenance organization, may own stock in and render their individual professional services through one professional service corporation.
(4) Professionals may organize a nonprofit nonstock corporation under this chapter and chapter 24.03 RCW to provide professional services, and the provisions of this chapter relating to stock and referring to Title 23B RCW shall not apply to any such corporation.
(5)(a) Notwithstanding
any other provision of this chapter, health care professionals who are licensed
or certified pursuant to chapters 18.06, ((18.19,)) 18.-- (sections 1
through 18 of this act), 18.22, 18.25, 18.29, 18.34, 18.35, 18.36A, 18.50,
18.53, 18.55, 18.57, 18.57A, 18.64, 18.71, 18.71A, 18.79, 18.83, 18.89, 18.108,
and 18.138 RCW may own stock in and render their individual professional
services through one professional service corporation and are to be considered,
for the purpose of forming a professional service corporation, as rendering the
"same specific professional services" or "same professional
services" or similar terms.
(b) Notwithstanding any other provision of this chapter, health care professionals who are regulated under chapters 18.59 and 18.74 RCW may own stock in and render their individual professional services through one professional service corporation formed for the sole purpose of providing professional services within their respective scope of practice.
(c) Formation of a professional service corporation under this subsection does not restrict the application of the uniform disciplinary act under chapter 18.130 RCW, or applicable health care professional statutes under Title 18 RCW, including but not limited to restrictions on persons practicing a health profession without being appropriately credentialed and persons practicing beyond the scope of their credential.
Sec. 24. RCW 18.205.090 and 1998 c 243 s 9 are each amended to read as follows:
(1) The secretary shall issue a certificate to any applicant who demonstrates to the secretary's satisfaction that the following requirements have been met:
(a) Completion of an educational program approved by the secretary or successful completion of alternate training that meets established criteria;
(b) Successful completion of an approved examination, based on core competencies of chemical dependency counseling; and
(c) Successful completion of an experience requirement that establishes fewer hours of experience for applicants with higher levels of relevant education. In meeting any experience requirement established under this subsection, the secretary may not require more than one thousand five hundred hours of experience in chemical dependency counseling for applicants who are licensed under chapter 18.83 RCW or under chapter 18.79 RCW as advanced registered nurse practitioners.
(2) The secretary shall establish by rule what constitutes adequate proof of meeting the criteria.
(3) Applicants are subject to the grounds for denial of a certificate or issuance of a conditional certificate under chapter 18.130 RCW.
(4) Certified chemical
dependency professionals shall not be required to be ((registered under
chapter 18.19 RCW)) licensed under chapter 18.-- RCW (sections 1 through
18 of this act).
Sec. 25. RCW 25.05.510 and 1998 c 103 s 1103 are each amended to read as follows:
(1) A person or group of persons licensed or otherwise legally authorized to render professional services, as defined in RCW 18.100.030, within this state may organize and become a member or members of a limited liability partnership under the provisions of this chapter for the purposes of rendering professional service. Nothing in this section prohibits a person duly licensed or otherwise legally authorized to render professional services in any jurisdiction other than this state from becoming a member of a limited liability partnership organized for the purpose of rendering the same professional services. Nothing in this section prohibits a limited liability partnership from rendering professional services outside this state through individuals who are not duly licensed or otherwise legally authorized to render such professional services within this state.
(2)(a) Notwithstanding
any other provision of this chapter, health care professionals who are licensed
or certified pursuant to chapters 18.06, ((18.19,)) 18.-- (sections 1
through 18 of this act), 18.22, 18.25, 18.29, 18.34, 18.35, 18.36A, 18.50,
18.53, 18.55, 18.64, 18.79, 18.83, 18.89, 18.108, and 18.138 RCW may join and
render their individual professional services through one limited liability partnership
and are to be considered, for the purpose of forming a limited liability
partnership, as rendering the "same specific professional services"
or "same professional services" or similar terms.
(b) Notwithstanding any other provision of this chapter, health care professionals who are licensed pursuant to chapters 18.57 and 18.71 RCW may join and render their individual professional services through one limited liability partnership and are to be considered, for the purpose of forming a limited liability partnership, as rendering the "same specific professional services" or "same professional services" or similar terms.
(c) Formation of a limited liability partnership under this subsection does not restrict the application of the uniform disciplinary act under chapter 18.130 RCW, or any applicable health care professional statutes under Title 18 RCW, including but not limited to restrictions on persons practicing a health profession without being appropriately credentialed and persons practicing beyond the scope of their credential.
Sec. 26. RCW 25.15.045 and 1999 c 128 s 2 are each amended to read as follows:
(1) A person or group of persons licensed or otherwise legally authorized to render professional services within this or any other state may organize and become a member or members of a professional limited liability company under the provisions of this chapter for the purposes of rendering professional service. A "professional limited liability company" is subject to all the provisions of chapter 18.100 RCW that apply to a professional corporation, and its managers, members, agents, and employees shall be subject to all the provisions of chapter 18.100 RCW that apply to the directors, officers, shareholders, agents, or employees of a professional corporation, except as provided otherwise in this section. Nothing in this section prohibits a person duly licensed or otherwise legally authorized to render professional services in any jurisdiction other than this state from becoming a member of a professional limited liability company organized for the purpose of rendering the same professional services. Nothing in this section prohibits a professional limited liability company from rendering professional services outside this state through individuals who are not duly licensed or otherwise legally authorized to render such professional services within this state. Persons engaged in a profession and otherwise meeting the requirements of this chapter may operate under this chapter as a professional limited liability company so long as each member personally engaged in the practice of the profession in this state is duly licensed or otherwise legally authorized to practice the profession in this state and:
(a) At least one manager of the company is duly licensed or otherwise legally authorized to practice the profession in this state; or
(b) Each member in charge of an office of the company in this state is duly licensed or otherwise legally authorized to practice the profession in this state.
(2) If the company's members are required to be licensed to practice such profession, and the company fails to maintain for itself and for its members practicing in this state a policy of professional liability insurance, bond, or other evidence of financial responsibility of a kind designated by rule by the state insurance commissioner and in the amount of at least one million dollars or a greater amount as the state insurance commissioner may establish by rule for a licensed profession or for any specialty within a profession, taking into account the nature and size of the business, then the company's members are personally liable to the extent that, had the insurance, bond, or other evidence of responsibility been maintained, it would have covered the liability in question.
(3) For purposes of applying the provisions of chapter 18.100 RCW to a professional limited liability company, the terms "director" or "officer" means manager, "shareholder" means member, "corporation" means professional limited liability company, "articles of incorporation" means certificate of formation, "shares" or "capital stock" means a limited liability company interest, "incorporator" means the person who executes the certificate of formation, and "bylaws" means the limited liability company agreement.
(4) The name of a professional limited liability company must contain either the words "Professional Limited Liability Company," or the words "Professional Limited Liability" and the abbreviation "Co.," or the abbreviation "P.L.L.C." or "PLLC" provided that the name of a professional limited liability company organized to render dental services shall contain the full names or surnames of all members and no other word than "chartered" or the words "professional services" or the abbreviation "P.L.L.C." or "PLLC."
(5) Subject to the provisions in article VII of this chapter, the following may be a member of a professional limited liability company and may be the transferee of the interest of an ineligible person or deceased member of the professional limited liability company:
(a) A professional corporation, if its shareholders, directors, and its officers other than the secretary and the treasurer, are licensed or otherwise legally authorized to render the same specific professional services as the professional limited liability company; and
(b) Another professional limited liability company, if the managers and members of both professional limited liability companies are licensed or otherwise legally authorized to render the same specific professional services.
(6)(a) Notwithstanding
any other provision of this chapter, health care professionals who are licensed
or certified pursuant to chapters 18.06, ((18.19,)) 18.-- (sections 1
through 18 of this act), 18.22, 18.25, 18.29, 18.34, 18.35, 18.36A, 18.50,
18.53, 18.55, 18.57, 18.57A, 18.64, 18.71, 18.71A, 18.79, 18.83, 18.89, 18.108,
and 18.138 RCW may own membership interests in and render their individual
professional services through one limited liability company and are to be
considered, for the purpose of forming a limited liability company, as
rendering the "same specific professional services" or "same
professional services" or similar terms.
(b) Notwithstanding any other provision of this chapter, health care professionals who are regulated under chapters 18.59 and 18.74 RCW may own membership interests in and render their individual professional services through one limited liability company formed for the sole purpose of providing professional services within their respective scope of practice.
(c) Formation of a limited liability company under this subsection does not restrict the application of the uniform disciplinary act under chapter 18.130 RCW, or any applicable health care professional statutes under Title 18 RCW, including but not limited to restrictions on persons practicing a health profession without being appropriately credentialed and persons practicing beyond the scope of their credential.
Sec. 27. RCW 48.43.087 and 1996 c 304 s 1 are each amended to read as follows:
(1) For purposes of this section:
(a) "Health carrier" includes disability insurers regulated under chapter 48.20 or 48.21 RCW, health care services contractors regulated under chapter 48.44 RCW, plans operating under the health care authority under chapter 41.05 RCW, the basic health plan operating under chapter 70.47 RCW, the state health insurance pool operating under chapter 48.41 RCW, insuring entities regulated under this chapter, and health maintenance organizations regulated under chapter 48.46 RCW.
(b) "Intermediary" means a person duly authorized to negotiate and execute provider contracts with health carriers on behalf of mental health care practitioners.
(c) Consistent with
their lawful scopes of practice, "mental health care practitioners"
includes only the following: Any generally recognized medical specialty of
practitioners licensed under chapter 18.57 or 18.71 RCW who provide mental
health services, advanced practice psychiatric nurses as authorized by the
nursing care quality assurance commission under chapter 18.79 RCW, psychologists
licensed under chapter 18.83 RCW, ((social workers, marriage and family
therapists, and mental health counselors certified under chapter 18.19 RCW))
and mental health counselors, marriage and family therapists, and social
workers licensed under chapter 18.-- RCW (sections 1 through 18 of this act).
(d) "Mental health services" means outpatient services.
(2) Consistent with federal and state law and rule, no contract between a mental health care practitioner and an intermediary or between a mental health care practitioner and a health carrier that is written, amended, or renewed after June 6, 1996, may contain a provision prohibiting a practitioner and an enrollee from agreeing to contract for services solely at the expense of the enrollee as follows:
(a) On the exhaustion of the enrollee's mental health care coverage;
(b) During an appeal or an adverse certification process;
(c) When an enrollee's condition is excluded from coverage; or
(d) For any other clinically appropriate reason at any time.
(3) If a mental health care practitioner provides services to an enrollee during an appeal or adverse certification process, the practitioner must provide to the enrollee written notification that the enrollee is responsible for payment of these services, unless the health carrier elects to pay for services provided.
(4) This section does not apply to a mental health care practitioner who is employed full time on the staff of a health carrier.
NEW SECTION. Sec. 28. A new section is added to chapter 70.02 RCW to read as follows:
Mental health counselors, marriage and family therapists, and social workers licensed under chapter 18.-- RCW (sections 1 through 18 of this act) are subject to this chapter.
NEW SECTION. Sec. 29. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.
NEW SECTION. Sec. 30. Sections 1 through 18 of this act constitute a new chapter in Title 18 RCW.
NEW SECTION. Sec. 31. The following acts or parts of acts are each repealed:
(1) RCW 18.19.010 (Legislative findings--Insurance benefits not mandated) and 1987 c 512 s 1;
(2) RCW 18.19.020 (Definitions) and 1991 c 3 s 19 & 1987 c 512 s 3;
(3) RCW 18.19.030 (Registration or certification required) and 1991 c 3 s 20 & 1987 c 512 s 2;
(4) RCW 18.19.040 (Exemptions) and 1987 c 512 s 4;
(5) RCW 18.19.050 (Powers of secretary--Application of uniform disciplinary act--Public education program) and 1991 c 3 s 21 & 1987 c 512 s 5;
(6) RCW 18.19.060 (Information disclosure to clients) and 1987 c 512 s 6;
(7) RCW 18.19.070 (Council established--Membership--Qualifications--Removal--Vacancy--Duties and powers--Compensation) and 1996 c 191 s 4, 1994 sp.s. c 9 s 501, 1991 c 3 s 22, & 1987 c 512 s 7;
(8) RCW 18.19.080 (Official records) and 1991 c 3 s 23 & 1987 c 512 s 8;
(9) RCW 18.19.090 (Registration of counselors and hypnotherapists) and 1991 c 3 s 24 & 1987 c 512 s 9;
(10) RCW 18.19.100 (Registration renewal) and 1996 c 191 s 5, 1991 c 3 s 25, & 1987 c 512 s 10;
(11) RCW 18.19.110 (Certification of social workers) and 1991 c 3 s 26 & 1987 c 512 s 12;
(12) RCW 18.19.120 (Certification of mental health counselors--Practice defined--Continuing education) and 1995 c 183 s 1, 1991 c 3 s 27, & 1987 c 512 s 13;
(13) RCW 18.19.130 (Certification of marriage and family therapists--Practice defined) and 1993 c 259 s 1, 1991 c 3 s 28, & 1987 c 512 s 14;
(14) RCW 18.19.140 (Applications for certification) and 1991 c 3 s 29 & 1987 c 512 s 17;
(15) RCW 18.19.150 (Examination of applicants for certification) and 1991 c 3 s 30 & 1987 c 512 s 16;
(16) RCW 18.19.160 (Certification of persons credentialed out-of-state--Temporary retirement of certified persons) and 1991 c 3 s 31 & 1987 c 512 s 19;
(17) RCW 18.19.170 (Renewal of certificates--Continuing education) and 1998 c 32 s 1, 1996 c 191 s 6, 1991 c 3 s 32, & 1987 c 512 s 15;
(18) RCW 18.19.180 (Confidential communications) and 1991 c 3 s 33 & 1987 c 512 s 11;
(19) RCW 18.19.190 (Other professions not affected) and 1987 c 512 s 18;
(20) RCW 18.19.900 (Short title) and 1987 c 512 s 20; and
(21) RCW 18.19.901 (Severability--1987 c 512) and 1987 c 512 s 28.
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